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Communications Technology

Ambulances to Get Virtual Doctors On Board 125

Posted by samzenpus from the for-the-virtual-sick dept.
nomrniceguy writes "Researchers are developing technology for ambulances to improve communications and perhaps more importantly, place virtual doctors inside in transit. A patient's vital signs and other data are beamed in real-time to the closest trauma center, where doctors can not only instruct paramedics in the field, but also prep a room to treat the critically injured once they arrive."
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Ambulances to Get Virtual Doctors On Board More

Ambulances to Get Virtual Doctors On Board

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  • Emergency (Score:2, Informative)

    by Grax ( 529699 )
    They had a device like this in the old television show "Emergency". They talked into this little thing and a doctor's voice came out of it and gave them advice on what to do. The doctor and nurse at the other end then prepared the trauma center for their arrival.

    Looks like they are expanding quite a bit on that idea though. Could be nice for certain rural areas.

    • Re:Emergency (Score:5, Insightful)

      by BoldAC ( 735721 ) on Friday December 31, 2004 @09:13AM (#11227096)
      As a doctor I have felt this was silly for a long time... our EMTs are well trained and usually do the right things in transport until they get to us.

      However, I have recently changed my mind.

      Several new studies have shown in sepsis (severe infections) that the early treatment is the most important treatment. When you combine this with the "early is better" studies in heart attacks and strokes, I think the time has come for this.

      Telemedicine is on its way... for better or for worse.

      • I think I agree that telemedicine in the field is a great idea for certain things (especially weird ALS interfacility transfers between hospitals), but the whole point of "prehospital medicine" is to get the patient to definitive care in one piece, correcting life-threatening problems as they go, preferably in better shape than when they found the patient. EMS is there to "fix big problems that can't wait," according to pre-established patient care protocols. Also, just for purposes of clarity, EMT != par

        • Whoa whoa whoa... (Score:3, Interesting)

          by The Tyro ( 247333 ) *
          And to be honest, physicians don't WANT paramedics bothering them at the emergency department for every incoming patient.

          I don't know what kind of ERs you deal with, but I'm usually very unhappy if a squad is inbound with a really sick patient and they DON'T call. That call gives me extremely valuable prep time, like calling for the difficult airway cart, getting my monster 8.5F subclavian trauma introducer ready, or opening a chest tube tray. If they just "roll in the door" with a pregnant-with-twins-a
          • You missed his point - he doesn't want telemedicine on every call, he didn't say that he wouldn't notify the ER/ED of incoming patients.
            • That's the whole reason we have protocols.
              They are very valuable out here in rural EMS.

              We usually have communication problems out in our county. Because of it's rural nature, we have almost no cell service. When you really get off into the backwoods we have a dense tree covering which doesn't allow sat phone use.

              I'm sure this new technology (I didn't RTFA yet) will be wonderful and could protentially save patients, but what about when it doesn't work?

              You need well-trained emergency service workers
          • You misread his statement:

            And to be honest, physicians don't WANT paramedics bothering them at the emergency department for
            every incoming patient.
            (Emphasis added)

            I think you two are in violent agreement. You both expect the EMT/paramedic to call in when they see a real problem. His point is that most ERs don't want a call about every single little side issue that comes up during transport.
          • As someone downthread posted, my comment was more directed toward online medical control than the quick radio reports we make to say "here we come!"

            I'm in complete agreement, and unless we had bizarre radio failure or a less-than-a-minute transport time with weird circumstances, I think it's always appropriate to give the "heads up" call to the ED.

            I would just say that when possible, I try to avoid bothering a physician for routine medical treatment, ALS or BLS, that won't require any immediate specialize

      • I don't know (Score:3, Insightful)

        by The Tyro ( 247333 ) *
        I used to be an EMS director... and I have reservations about putting certain things too far out in the resuscitation chain.

        That said, I agree with you; Early treatment is arguably better for many things... assuming that early treatment saves more lives than it costs.

        For instance, Thrombolytics for stroke. I find very few patients actually qualify for that particular intervention, either because they ignore their symptoms and miss the 3-hour window, or because they have contraindications. Despite the NI

        • Re:I don't know (Score:3, Informative)

          by Long-EZ ( 755920 )
          When expert systems were all the rage in the early 1980s, someone had the idea to train a computer using the diagnostic techniques of a bunch of really good doctors. The goal was a "doctor" for every third world village. The computer ordered simple tests and posed diagnostic questions in the proper sequence. A nurse or similarly skilled technician did all the hands-on stuff. They tested the effectiveness of this fairly simple prototype. It was *way* better than the average American doctor at diagnosing
          • does NOT work.

            It was *way* better than the average American doctor at diagnosing illness and injury and recommending appropriate treatment...
            Tin foil hat time: We don't hear about this project anymore. Why not? The evil AMA (probably in league with those guys in the black helicopters) suppressed the technology. OK, I'm mostly joking

            I'm glad to hear you're joking... because I'd have see some serious proof of that claim. Remember, you're talking about human lives here... and the lawyers will be watching,

            • Want to do it better and cheaper than me? By all means, be my guest.

              I'm certain the AMA would have no problem with me practicing medicine.

              I'm not advocating that anyone should be able to practice medicine. Obviously, some strict regulation is required. But anytime a monopoly is granted, there is no competition. Prices soar, while quality takes a nose dive. The question becomes, how do we regulate medical practice while avoiding a monopoly?

              they present with atypical symptoms, or a less-than-classic

              • and my apologies for what may have come across as an overly critical post.

                For the record, I echo your lament about the inadequacy of some of our testing. My kingdom for a better test for Pulmonary Embolus, for instance.

                Computer systems may be better at picking pertinent data points out of the noise... but who trains the machine? A fallible human tells the system what data points to count and discard... the system is only as good as its programmer.

                The point I was making (in a not completely elegant fash

                • who trains the machine? A fallible human tells the system what data points to count and discard... the system is only as good as its programmer.

                  On the contrary. Expert systems are not simply as good as the weakest link. A better model would be a synergistic system that is better than its best single component. Through an iterative process, knowledge is added to an expert system and mistakes are eliminated. Unlike a doctor, there is no gradual decline in currency and attention span over time. Expert

      • I agree that telemedicine is on its way for a variety of things. But as a pediatrician (who spends most of my clinical time in a tertiary-care emergency department) I have to wonder how exactly you send a physical examination via telemedicine. I love the idea of sending vitals, except that I really don't look that much at the exact numbers (I'd like them to have a decent blood pressure, a nonzero pulse, and some reasonable respirations; beyond that, everything's negotiable). The first decision in pediatrics

    • Re:Emergency (Score:4, Insightful)

      by Bitsy Boffin ( 110334 ) on Friday December 31, 2004 @09:48AM (#11227238) Homepage
      They talked into this little thing and a doctor's voice came out of it and gave them advice on what to do. The future is here! I've got one of those things, I can't remember what it's called, it's on the tip of my tongue, umm, err, hang on, let me get the box.... ahh here it is, they call it a "Mobile Phone". Amazing.
    • They had a device like this in the old television show "Emergency". They talked into this little thing and a doctor's voice came out of it and gave them advice on what to do.

      Uhhh, that "little thing" they talked into is called a two-way radio. Duh.

  • Better Attitude (Score:5, Funny)

    by Yo Grark ( 465041 ) on Friday December 31, 2004 @09:07AM (#11227063)
    PLEASE make sure his matrix can handle singing, art, and while you're at it, give him a WAY Better attitude. Align the holo-emitters so he can travel outside the prep-room, oh and might as well make sure he has hair for vanities sake :P

    Yo Grark

  • Wonderful (Score:3)

    by Turn-X Alphonse ( 789240 ) on Friday December 31, 2004 @09:07AM (#11227065) Journal
    In the UK there is a HUGE shortage on doctors and nurses. Having them sitting in a room talking to (fully trained) ambulance crews is all we need.

    I can see a use to this but surely the money would be better spent on getting more doctors, nurses and medics. We already have radio systems which work perfectly fine.

    • Re:Wonderful (Score:2, Interesting)

      by 16K Ram Pack ( 690082 )
      It depends. If it means that you can get a patient treated faster, it can actually save on medical time later treating complications etc.
      • Like I said in my earlier comment [slashdot.org], this is nothing new. Paramedics can give nitrates for chest pain, draw bloods for analysis at the hospital, administer oxygen, perform endotracheal intubation, interpret life-threatening heart rhythms, etc. In most cases, we can already do this without calling a physician and asking permission.

        This is basically "offline medical control" in the form of standing orders. Physicians get together, decide what's best for the patient and a particular geographic area, and allo

    • Re:Wonderful (Score:1, Flamebait)

      by MichaelSmith ( 789609 )
      Having them sitting in a room talking to (fully trained) ambulance crews is all we need.

      They could be Indian or Chinese doctors and nurses. Communications are cheap these days

    • Where are you going to get those doctors? I don't qualify, and there are many like me. I'm smart enough, I could (if I studied enough) pass med school. However I don't work well in these situations. I don't like working with people (what do you expect, I'm writing this to slashdot), and I try to spend as much time as needed figuring out the solution before I jump in. Great in a programmer, but when seconds count I'd kill people.

      I'm not alone, many people are like me. There are many more who are b

  • Woohoo! (Score:3, Funny)

    by Vampyre_Dark ( 630787 ) on Friday December 31, 2004 @09:08AM (#11227071)
    Now all across north america, ambulances will be pulled over, with the occupants in the back playing World of Warcraft. :)
  • Please, give the poor doctor a name. And, on the off chance that an ambulance with one of these on board is stranded in some remote area for years, please make a female one too.

    Oh man, that's so geeky.
  • One of the things I'm curious about, is why they haven't taken this to the next step of making the field hospital "removable" from the ambulance so you can be treated remotely in your home? For many calls, the patient could be stabilized and monitored with less risk all around if they didn't have to actually travel to the hospital.

    Obviously that wouldn't work in the case of a car wreck or a fire, but if you're having a heart attack or stroke and you are just going to be stabilized and medicated anyway...

    • Its a support issue.
      A patient in a traumatic situation may require a large team of people, and the best place to get that is still the hospital.
      This doctor is only going to be as backup for the triage the field medics can perform.
      Over here in the UK, we have a system where paramedics are sent out alone on motorbikes and smaller ambulances, they cannot return the patient to a hospital, but can usually get to an incident scene faster, and begin assessment and initial treatment faster than a larger ambulance.
    • Ask this question: why would doctors and hospitals be interested in doing such a thing?
      • Ask this question: why would doctors and hospitals be interested in doing such a thing?

        There are many conditions, esp. cardiac arrythmias, that if treated early, can prevent serious consequences. We are not talking full fledged medical exams, we are talking scoop and run, relay important info, and have ER staff standing by. As far as treatment in route, there is a sort of flow chart anyway, if this is wrong do this, if the patient has problems breathing, give oxygen. That is oversimplified, but I think y

    • Probably because when they don't need to be transfered to the hospital straight away, they still need to be transfered there at some stage? Why leave the patient at risk and come back for them later when you can stabalise them on the way to the hospital?

      And does this mean that when the ambulance leaves, it's going to have to go back and pick-up another crew and supplies from somewhere? Or is it going to carry around extra?

    • For some time in the late 1990s and even into 2001 or so (and there are occasional rumblings even today) a segment of the EMS field pushed for a higher level of paramedic care that would do just that - "treat and street" as someone posted in this thread.

      The biggest problem was the way that Medicare treats ambulance service. Except in very limited circumstances under the "paramedic intercept" code, in order to bill Medicare for an ambulance call, you have to actually transport the patient in your ambulance

    • In principle, I love it. But it's a matter of equipment and staff. "Stabilizing" a patient requires providing appropriate support for their illness, treatment that might involve one of a thousand drugs, a bunch of different devices, and a subset of several dozen different kinds of trained staff. And then you have to give them time to get better.

      Which is what a hospital is all about. It's unfortunate that it's a nest for nosocomial disease, inconvenient for everyone involved, and the kind of place that you

    • You're looking at something bigger than an ambulance then, something RV sized. Ambulances have a ton of stuff, shelves and shelves of items but they lack so much more that a real ER has. Some of the major Emergency departments have mobile field hospitals , like in cities, but its only for mass casualty incidents.

      Even so, its not that useful. 90% of my EMT calls are minor things, we don't even give them oxygen or put the sirens on for many of them. A roaming ER doesn't do much good if its only for a kid wit

  • Bad time for a... (Score:4, Funny)

    by TLLOTS ( 827806 ) on Friday December 31, 2004 @09:15AM (#11227102)
    Ambulance Officer: "Ok, so after I've made the incision, what do I do?"

    Virtual Doctor: "After that, quickly check for signs of internal bleeding, but whatever you don't-"

    Monitor: "You have experienced a fatal error, please restart your Virtual Doctor, if this problem persists please contact your administrator"

    (long beep heard in the background)

    Ambulance Officer: "Oh crap, not again!"
  • on since the 1980's. I am an ER nurse. The paramedics would hook the pateint up, and we could watch his heart rate and beat. We could talk to them , and relay treatment plans.

  • More responsibility (Score:3, Insightful)

    by Davak ( 526912 ) on Friday December 31, 2004 @09:17AM (#11227117) Homepage
    Oh, our poor malpractice fees!

    Now I have to be responsible for the transport as well? I can run servers looking at data on a screen just fine... but running a code?

    Plus, the EMTs are trained to do their job... and now you are going to have little ole me barking orders to these guys who have been doing it solo for years and years.

    Does my extra knowledge better for the patient than their physicial being there? They can touch and physicially examine the poor guy... I can just sit there and look at numbers.

    When I see the study that shows that this actually saves lives, then I will believe it. Until then, I believe it's just a another tech company trying to stir up interest in investors.

    • EMTs are well trained, but not nearly as well as other doctors. In addition they are trained to deal with life or death, seconds count things. If it is just a kidney stone it isn't important enough for them to waste time remembering what to do. (Remember there are thousands of things that can go wrong, you would be dead before you learned them all!) Back at the hospital there are hundreds of doctors who can give advice. All it takes is an expert in the area to give advice, and they can start solvin

  • Would you like me to:
    * Notify next of kin
    * Laugh maniaclly
    * Irritate you until you bleed out
    * Actually shut up and get on with fixing you
  • "Emergency Medical Hologram reporting for duty, please state the nature of your medical emergency"

    http://forums.fark.com/cgi/fark/comments.pl?IDLink =1278856 [fark.com]
  • There is a similar smart device [google.com] in use over here in Munich/Germany.
    (Google translate)

    It detatches via remotecontrol, only if you confirm the incident with an expert. Then it "talks" you through the whole process. If it is not a real heartattack the device won't go off (could be used for fun stuff if it would ;-) and instruct you with further first aid measures.

    Not sure if those actually saved lives yet...
  • How long til virtual lawyers in the ambulance? It is probably a matter if when, not if.
  • A device like this one already exists, and is in common use. Couple your average cell phone (after calling madical control at the ED) with a LIFEPAK 12 [medtronic-ers.com] (which uses a pc card modem) and poof, you have the same package for $25,000.

    I do this all the time as an EMT and there is always a team of Nurses and Doctors waiting for me as I roll into the trauma room, as I have called ahead and told/showed them what I have.

    On a side note, I like the idea of taking the ED to the people, and the USDOT is working on m

  • From working within the EMS industry, I can tell for certain that Paramedics will despise the ides of a doctor riding along, even in just virtually. Sure, the idea would make sense in a perfect world, but in reality, I never see this sort of thing working for an EMS crew situation. Besides the fact that no EMS company is going to want to foot the bill for the equipment, there is the human ego part involved where they don't want what they do second-guessed. They are trained for a reason. (mind you, I am
  • Can you pay the outrageous bills with virtual money?
  • They're all coming out and posting in this thread...

    How long before the lawyers on Slashdot start crawling out of the woodwork? :D
  • BEEMED?

    Hell, "beem" the patient, scotty.
  • In the US you'll get the virtual billing clerk asking, "Do you have insurance?"

    Please swipe patient's insurance card to continue.

  • Bad idea (Score:3, Informative)

    by Dan East ( 318230 ) on Friday December 31, 2004 @10:40AM (#11227495) Journal
    This is one of these ideas dreamed up by someone outside of the healthcare industry. I've worked in EMS / Emergency Department for a decade, and can tell you this will not be utilized or be useful for a number of reasons.

    Anyone remember the Emergency! TV show back in the 70s? The paramedics would always send telemetry back to the ED, where a physician (with nothing else better to do than to sit by the 'phone' waiting for someone out in the field to call in) would take a look at the ECG and tell the paramedic what to do. Well, fortunately we've gone far beyond that - those in the field are trained to identify dysrhythmia and treat it properly. Even a Cardiac Tech (here in Virginia), which is below a paramedic, can utilize every drug in the drug box. What is proposed in this story would be a complete step in the wrong direction, taking us back 3 decades.

    Two other reasons - ED docs are plenty busy enough taking care of patients that are sitting right in front of them. They need to delegate caregiving to others. Often times we have brought patients into the ED and they were so busy that we (EMS) helped treat other patients in the ED!

    Liability. No doctor would put their neck on the line and tell someone that is not certified to do something beyond their training. That is what this is all about, putting a virtual physician in the ambulance. Physicians cannot make decisions without lab work, 12 lead ECGs, radiology, etc.

    About a year ago Slashdot carried a story about cars getting "black boxes" like the flight recorders on airplanes (can't find the story using Slashdot's search). The industry (ie insurance industry) claimed that would help physicians treat patients that had been in car wrecks. At the time I posted how absurd that was - patients are treated the same regardless of what may or may not have happened to them. The worst should always be assumed (spinal injuries, etc). We've seen people killing in minor (low-G) wrecks, and people walk away unscathed (after we cut them out of the car) from vehicles that were twisted into a pretzel. This sounds like another case of technology misapplied by an industry out of touch with the needs of those they are supposed to be helping.

    Dan East
  • Telemetry in EMS was started in the 1960s and was widespread by the 1980s (cf. Jack Webb's "Emergency!"). The cardiac monitor was set up to modulate a 1000 Hz tone that was transmitted via radio or landline. Newer systems use fax to transmit 12-lead EKGs.

    Turns out, though, that Paramedics can be just as good at reading EKGs as MDs, so in a lot of places, "sending a strip" is rarely done.

    Adding the ability to send other vitals (O2 sat, T/P/R, BP, etc) is a fine idea, but all they seem to be doing here i
  • "You've got leprosy. Goodbye."
  • That's a big step in the wrong direction.
    I spent 10 years as a Paramedic in Pensylvania. During that time, the trend was to REDUCE the amount of base communications. There is a reason the old caridac telemetry systems (like the old "Emergency" show) disappeared. It turns out that it is far more effective to have the person who is nose to nose with the patient making the treatment decisions in the field. ("Treat the patient, not the monitor")
    As a result, paramedics have been tethered less and less
  • Now hospitals will be able to check on the ambulances to make sure the EMT's are doing their job and not stopping at their girlfriend's house on the way to an emergency scene.

    Sound familiar? http://yro.slashdot.org/article.pl?sid=04/12/30/16 23208&tid=158&tid=126 [slashdot.org]
  • If you skip the misleading portions of the article, you'll find that the only new thing here is using a maritime satellite for the connection. They're already putting EMTs in direct contact with doctors at the hospital they're going to and sending data from the ambulance to the hospital. The problem is that they go through places without cell reception and where point-to-point links are blocked by terrain.
  • ...will they be able to get permission to use Robert Picardo's likeness?
  • Background: I was an EMT in Charlottesville, VA in the late 1970s, where we had a program to provide telemetry to the University of Virginia ED. I have been an emergency physician at a Level I Trauma Center for about 20 years. I helped write chunks of three different editions of the DOT EMT-P curriculum.

    The idea of telemetry is not new, and has been used both experimentally and in the field by the military. However, I think this is a solution looking for a problem. What defect in the existing EMS system wi
  • Haven't you read Larry Niven's "Ringworld" and related works? The http://www.larryniven.org/images/rc/ss65.jpg [larryniven.org]autodo c is a device that would be conceivabley fit in a large ambulance, and as long as you can crawl inside, or someone place you there, it can automatically diagnois and treat any injury or sickness. Exotic alien species? No problem. Multiple organ transplants and limb amputations? It's got plenty of spare parts available!

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